NR 509
FINAL EXAM
Expected Questions with Answers
(Advanced Physical Assessment)
Chamberlain
What You Will Get:
Instant PDF download
100 multiple-choice questions
Verified answers included
Detailed rationales for review
Advanced Physical Assessment focused
Great for Final exam review and self-study
Please note: This is an independent study resource and is not affiliated
with or endorsed by Chamberlain University.
,1. A 68-year-old former paleontologist presents to clinic with concerns about her
breast cancer risk. Her mother developed the disease in her 50s and died from it in her
60s. A younger cousin developed the disease a few years ago before the age of 50
years, but this individual was not tested for the BRCA1 and BRCA2 genes. In addition,
the patient suffered from lymphoma in her 20s and had radiation to the chest. She did
take hormone replacement therapy for a few years before data emerged that this may
contribute to breast cancer risk. She has had several abnormal mammograms in her
50s for persistently dense breasts with subtle findings, but follow-up biopsies never
showed any malignant pathology. Which of the following is true regarding magnetic
resonance imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not extraordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the
expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy
patients).
d. Breast MRI is the sole recommended screening modality for women with a history of
chest radiation.
e. Hormone replacement therapy history alone is sufficient to qualify for MRI screening.
Correct Answer: C — Regardless of recommendations, the high sensitivity of breast
MRI comes at the expense of markedly decreased specificity (i.e., the ability to rule
out disease in healthy patients).
Rationale: This patient has moderate risk factors (family history, chest radiation, HRT
use, dense breasts), but breast MRI is primarily recommended for high-risk women (e.g.,
BRCA carriers, lifetime risk >20–25%). MRI has very high sensitivity (around 90%) but
lower specificity than mammography, resulting in more false positives, callbacks, and
biopsies. The USPSTF does not recommend routine MRI for average-risk or moderate-
risk women. Chest radiation history increases risk but does not alone mandate MRI
without other high-risk features.
,2. A 66-year-old female museum curator presents for a routine annual examination.
On examination, a notably enlarged supraclavicular lymph node is appreciated on the
right side. The lymph node is nontender and feels firm and rubbery. She denies any
localized or systemic symptoms such as breast lumps, fevers, or night sweats. She has
been taking conjugated estrogen tablets for 9 years since menopause, though she has
not taken progestin compounds since she had a hysterectomy for heavy bleeding at
age 45 years. Which of the following is true about this presentation of
lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics
of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the
neck.
d. Firm, rubbery lymph nodes are generally considered to be benign.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
Correct Answer: E — Metastatic breast cancer cells may spread directly into the
infraclavicular and then supraclavicular nodes without first causing notable changes in
the axillary nodes.
Rationale: The supraclavicular lymph nodes (particularly on the left, Virchow's node) are
a critical drainage site for thoracic and abdominal malignancies. In breast cancer,
metastasis can bypass the axilla and spread directly to infraclavicular and supraclavicular
nodes. A firm, rubbery, nontender node in a postmenopausal woman on long-term
estrogen therapy is suspicious for malignancy and requires urgent workup, including
breast imaging and possible biopsy. Supraclavicular nodes are never considered "benign
by location" and always warrant evaluation when enlarged.
3. A 44-year-old female mathematician presents to clinic with a complaint of a mass in
the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty
because she has only had one mammogram and does not engage in breast self-
examination (BSE) on any regular basis. She has no family history of breast cancer, and
her prior mammogram was ordered as a routine screening test at age 43 years after a
, brief discussion with her primary care provider. After a thorough investigation reveals
a benign cyst, what advice should be given to this patient about screening for breast
cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught
and performed regularly.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of
annual examinations starting at age 30.
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint.
d. Mammography is most sensitive and specific for women in their 40s, when breast
tissue is still dense enough to image.
e. Breast cancer screening is extremely well studied and all guidelines agree on uniform
screening protocols.
Correct Answer: C — This patient was in compliance with the U.S. Preventive Services
Task Force (USPSTF) recommendations for her age group and risk factors prior to her
current complaint.
Rationale: The USPSTF recommends biennial screening mammography for women aged
50–74. For women aged 40–49, the decision to screen should be individualized based on
risk factors and patient preference. This 44-year-old with average risk and a prior
screening mammogram at 43 was within the bounds of individualized decision-making.
BSE is not routinely recommended by major agencies because evidence does not show
reduced mortality. CBE alone is not superior to mammography for screening.
4. A 42-year-old female website developer presents for an annual preventive
examination with questions about breast cancer screening. She is concerned about the
radiation exposure associated with mammography and is interested in magnetic
resonance imaging (MRI) as a possible alternative for routine screening. She is
otherwise healthy with no family history of breast, ovarian, or colon cancer. Which of
the following is true about MRI as a screening modality for breast cancer in the
general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
FINAL EXAM
Expected Questions with Answers
(Advanced Physical Assessment)
Chamberlain
What You Will Get:
Instant PDF download
100 multiple-choice questions
Verified answers included
Detailed rationales for review
Advanced Physical Assessment focused
Great for Final exam review and self-study
Please note: This is an independent study resource and is not affiliated
with or endorsed by Chamberlain University.
,1. A 68-year-old former paleontologist presents to clinic with concerns about her
breast cancer risk. Her mother developed the disease in her 50s and died from it in her
60s. A younger cousin developed the disease a few years ago before the age of 50
years, but this individual was not tested for the BRCA1 and BRCA2 genes. In addition,
the patient suffered from lymphoma in her 20s and had radiation to the chest. She did
take hormone replacement therapy for a few years before data emerged that this may
contribute to breast cancer risk. She has had several abnormal mammograms in her
50s for persistently dense breasts with subtle findings, but follow-up biopsies never
showed any malignant pathology. Which of the following is true regarding magnetic
resonance imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not extraordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the
expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy
patients).
d. Breast MRI is the sole recommended screening modality for women with a history of
chest radiation.
e. Hormone replacement therapy history alone is sufficient to qualify for MRI screening.
Correct Answer: C — Regardless of recommendations, the high sensitivity of breast
MRI comes at the expense of markedly decreased specificity (i.e., the ability to rule
out disease in healthy patients).
Rationale: This patient has moderate risk factors (family history, chest radiation, HRT
use, dense breasts), but breast MRI is primarily recommended for high-risk women (e.g.,
BRCA carriers, lifetime risk >20–25%). MRI has very high sensitivity (around 90%) but
lower specificity than mammography, resulting in more false positives, callbacks, and
biopsies. The USPSTF does not recommend routine MRI for average-risk or moderate-
risk women. Chest radiation history increases risk but does not alone mandate MRI
without other high-risk features.
,2. A 66-year-old female museum curator presents for a routine annual examination.
On examination, a notably enlarged supraclavicular lymph node is appreciated on the
right side. The lymph node is nontender and feels firm and rubbery. She denies any
localized or systemic symptoms such as breast lumps, fevers, or night sweats. She has
been taking conjugated estrogen tablets for 9 years since menopause, though she has
not taken progestin compounds since she had a hysterectomy for heavy bleeding at
age 45 years. Which of the following is true about this presentation of
lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics
of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the
neck.
d. Firm, rubbery lymph nodes are generally considered to be benign.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
Correct Answer: E — Metastatic breast cancer cells may spread directly into the
infraclavicular and then supraclavicular nodes without first causing notable changes in
the axillary nodes.
Rationale: The supraclavicular lymph nodes (particularly on the left, Virchow's node) are
a critical drainage site for thoracic and abdominal malignancies. In breast cancer,
metastasis can bypass the axilla and spread directly to infraclavicular and supraclavicular
nodes. A firm, rubbery, nontender node in a postmenopausal woman on long-term
estrogen therapy is suspicious for malignancy and requires urgent workup, including
breast imaging and possible biopsy. Supraclavicular nodes are never considered "benign
by location" and always warrant evaluation when enlarged.
3. A 44-year-old female mathematician presents to clinic with a complaint of a mass in
the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty
because she has only had one mammogram and does not engage in breast self-
examination (BSE) on any regular basis. She has no family history of breast cancer, and
her prior mammogram was ordered as a routine screening test at age 43 years after a
, brief discussion with her primary care provider. After a thorough investigation reveals
a benign cyst, what advice should be given to this patient about screening for breast
cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught
and performed regularly.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of
annual examinations starting at age 30.
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint.
d. Mammography is most sensitive and specific for women in their 40s, when breast
tissue is still dense enough to image.
e. Breast cancer screening is extremely well studied and all guidelines agree on uniform
screening protocols.
Correct Answer: C — This patient was in compliance with the U.S. Preventive Services
Task Force (USPSTF) recommendations for her age group and risk factors prior to her
current complaint.
Rationale: The USPSTF recommends biennial screening mammography for women aged
50–74. For women aged 40–49, the decision to screen should be individualized based on
risk factors and patient preference. This 44-year-old with average risk and a prior
screening mammogram at 43 was within the bounds of individualized decision-making.
BSE is not routinely recommended by major agencies because evidence does not show
reduced mortality. CBE alone is not superior to mammography for screening.
4. A 42-year-old female website developer presents for an annual preventive
examination with questions about breast cancer screening. She is concerned about the
radiation exposure associated with mammography and is interested in magnetic
resonance imaging (MRI) as a possible alternative for routine screening. She is
otherwise healthy with no family history of breast, ovarian, or colon cancer. Which of
the following is true about MRI as a screening modality for breast cancer in the
general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
